
Peter GiannoudisUniversity of Leeds · Leeds Institute of Molecular Medicine (LIMM)
Peter Giannoudis
BSc,MB, MD, FACS, FRCS
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Introduction
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Publications
Publications (1,233)
Mesenchymal stem cells are core to bone homeostasis and repair. They both provide the progenitor cells from which bone cells are formed and regulate the local cytokine environment to create a pro-osteogenic environment. Dysregulation of these cells is often seen in orthopaedic pathology and can be manipulated by the physician treating the patient....
Intertrochanteric fractures are a common type of proximal femoral
fracture, and account for high morbidity and mortality. Early recognition and management of such fractures is important, with surgery
preferably undertaken within 48 hours. The choice of surgical strategy
remains variable between centres and individual surgeons; in part
because evide...
Introduction
Skeletal muscle wasting is an important clinical issue following acute traumatic injury, and can delay recovery and cause permanent functional disability particularly in the elderly. However, the fundamental mechanisms involved in trauma-induced muscle wasting remain poorly defined and therapeutic interventions are limited.
Objectives...
Purpose
Metastatic disease of the pelvis is frequently associated with severe pain and impaired ambulatory function. Depending on the patient’s characteristics, primary tumor, and metastatic pelvic disease, the treatment choice may be varied. This study aims to report on the current management options of metastatic pelvic disease.
Methods
We compr...
Introduction
Infected tibial non-unions with associated bone loss can be challenging to manage. At present, the two main methods utilized in the management of these fractures include the Ilizarov technique of Distraction Osteogenesis (DO) using external fixator devices, or alternatively, the Induced Membrane Technique (IMT), devised by Masquelet. A...
Purpose
Obstetric outcomes in women following pelvic injuries requiring surgical fixation is not thoroughly known. We aimed to evaluate if radiographic measurements (RMs) can be used to provide information on delivery methods outcome after these injuries, and to evaluate if metal work removal is required prior to delivery.
Method
A retrospective s...
Purpose
The aim of this study was to evaluate the results of distal femoral fracture fixation of two different methods, lateral locking plate (LP) or an Intra-medullary nail (IMN), in patients managed in our institution. More specifically, to assess: (a) if there was a difference in functional outcomes between the LP and IMN groups; (b) whether the...
A prospective, feasibility, randomised study was performed to compare intramedullary versus extramedullary fixation of unstable pertrochanteric fractures and to assess the feasibility of including patients with dementia. From July 2016 to November 2017, 60 consecutive patients with an unstable pertrochanteric (OTA/AO 31-A2) fracture were randomized...
Reconstructive surgery of the clavicle using free vascularised fibula grafting (FVFG) is sometimes required for the management of severe bone loss or non-union. As the procedure is relatively rare, there is no universal agreement on the management and outcome. This systematic review aimed to first, identify the conditions for which FVFG has been ap...
Bone damage arising from fractures or trauma frequently results in infection, impeding the healing process and leading to complications. To overcome this challenge, we engineered highly porous chitosan scaffolds (S1, S2, and S3) by incorporating 30 (wt)% iron-doped dicalcium phosphate dihydrate (Fe-DCPD) minerals and different concentrations of cer...
Aims:
Loosening of components after total knee arthroplasty (TKA) can be associated with the development of radiolucent lines (RLLs). The aim of this study was to assess the rate of formation of RLLs in the cemented original design of the ATTUNE TKA and their relationship to loosening.
Methods:
A systematic search was undertaken using the Cochra...
The management of patients with multiple injuries remains challenging. Patients presenting with comorbidities, such as diabetes mellitus, may have additional unpredictable outcomes with increased mortality. Therefore, we aim to investigate the impact of major trauma centres in the UK on the outcomes of polytrauma patients with diabetes. The Trauma...
Management of severely injured patients remains a challenge, characterised by a number of advances in clinical practice over the last decades. This evolution refers to all different phases of patient treatment from prehospital to the long-term rehabilitation of the survivors.
The spectrum of injuries and their severity is quite extensive, which di...
The ability to enhance fracture healing is paramount in modern orthopaedic trauma, particularly in the management of challenging cases including peri-prosthetic fractures, non-union and acute bone loss.
Materials utilised in enhancing fracture healing should ideally be osteogenic, osteoinductive, osteoconductive, and facilitate vascular in-growth....
Introduction
There are currently no standardised guidelines on whether antibiotic prophylaxis is required for Kirschner wire (K-wire) fixation to minimise the risk of surgical site infection when used in patients undergoing clean orthopaedic surgery.
Purpose
To compare the outcomes of antibiotic prophylaxis versus no antibiotic in K-wire fixation...
Lately, the care of severely injured patients in the United Kingdom has undergone a significant transformation. The establishment of regional trauma networks (RTN) with designated Major Trauma Centers (MTCs) and satellite hospitals called Trauma Units (TUs) has centralized the care of severely injured patients in the MTCs. Pelvic fractures are noto...
Multiple myeloma (MM) shows constitutive activation of canonical and non-canonical nuclear factor-ĸB (NF-ĸB) signaling through genetic mutations or stimuli from the tumour microenvironment (TME). A subset of MM cell lines showed dependency for cell growth and survival on the canonical NF-ĸB transcription factor RELA alone, suggesting a critical rol...
Purpose:
To establish the current peer-reviewed practices in the discipline of orthopaedic surgery and correlate these to the journal's impact factor. Unfortunately, this is not receiving much attention and a critical literature gap in various disciplines; thus, determining the current practices in the discipline of orthopaedic surgery could provi...
Tibial plateau fractures range from simple to complex. Most complex injury types are managed surgically but for some, a decision is made to treat without surgery. We present a case that was managed non-operatively but due to failure of bone union, later required surgical intervention. We discuss the choice of management and potential risk factors i...
With a growing number of patients undergoing total knee replacements globally, coupled with an elderly population, the incidence of periprosthetic fractures around total knee replacements is increasing. As such, this is a highly topical subject that is gaining increasing interest within the orthopaedic community. This review provides a narrative sy...
Introduction
Carbon fibre-reinforced polyetheretherketone (CFR-PEEK) plates represent an exciting development within trauma and orthopaedic surgery, offering advantages including radiolucency, material properties similar to bone, and lack of localised tissue reaction. As more call for trials examining their use, there is no data available as to the...
Our aim was to systematically review literature of trauma related rotator cuff tears in order to evaluate the outcome and healing integrity in relation to time of surgery. Our research question was whether earlier surgical repair leads to superior functional results. This review was conducted according to PRISMA statement. A literature search of Pu...
By definition, anteroposterior (AP) compression type 1 (APC-1) injury is a type of pelvic ring injury, which is widely acknowledged as ‘stable’. Unstable forms of this injury are very rare and present a challenge for diagnosis and clinical management. Detailed herein is a man in his early 30s, referred to our institution with a 2-year history of pu...
Introduction:
Intramedullary (IM) nails are considered the 'gold' standard treatment for subtrochanteric femoral fractures. The incidence and risk factors for re-operation in subtrochanteric fractures remain unclear. Furthermore, no studies have compared the outcomes of different nailing systems used to treat subtrochanteric fractures in the same...
During the past decade, more and more large-scale pragmatic clinical trials have been carried out in orthopedic trauma surgery. This trend is fueled by the common belief that the larger the numbers in a trial, the broader the eligibility criteria, and the less strict the regimentation of local treatment standards by protocol, the more trustworthy t...
Over the last year, with the social isolation imposed by the coronavirus disease pandemic, there has been a significant increase in complaints associated with physical violence against women. In the present study, an exploratory literature review was carried out on the role of the on-call orthopedic surgeon when faced with a suspicion of domestic v...
Purpose
The cost implications of limb reconstruction techniques have not been adequately investigated. Aim of this pilot study was to compare the direct medical cost of tibial bone defects managed with distraction osteogenesis–Ilizarov method (ILF), or with Masquelet technique (MIF).
Methods
Data of 20 random patients treated in a single centre we...
Dear readers, greetings for the day. We hope this editorial
finds you well.” These introductory words will certainly sound familiar to you, from the numerous spam emails that reach your email inbox every day. The senders of these invitations invite you to submit your research work, review articles or a short communication to journals with names tha...
Distal femoral fractures in elderly or osteoporotic patients constitute a challenging injury, especially in the settings of fracture comminution or periprosthetic fractures. A recent trend in the treatment of these difficult injuries is the double fixation with a nail and a plate, a strategy that comes with advantages including faster weight-bearin...
Background
Our objective was to identify acetabular fractures in the elderly population (over 60 years of age), treated with open reduction and internal fixation (ORIF), and to examine their outcomes, primarily the risk for need for further surgery in the form of a total hip arthroplasty (THA), and factors associated with it. Additional outcomes su...
Purpose
Whilst recurrence and amputation rates in post-traumatic osteomyelitis (PTOM) are described, limb specific functional outcomes are not, leading to a knowledge gap when counselling patients prior to management. We aim to investigate the patient reported outcomes (PROMS) of this patient group to provide reference for discussions with patients...
Dicalcium Phosphate Dihydrate (DCPD) mineral scaffolds alone do not possess the mechanical flexibility, ease of physicochemical properties’ tuneability or suitable porosity required for regenerative bone scaffolds. Herein, we fabricated highly porous freeze-dried chitosan scaffolds embedded with different concentrations of Dicalcium Phosphate Dihyd...
Purpose
The unprecedented COVID-19 experience has posed severe challenges to the health care system and several of these are documented in orthopaedic surgery; however, although the pandemic has also brought positive changes, these have not been precisely documented. The purpose of this survey is to identify positive perceptions by orthopaedic surg...
The first Trauma and Orthopaedic unit dates back to 1780, originally dedicated to the treatment of children's deformities. The specialty has subsequently become multifaceted, with a plethora of subspecialty areas of which Orthopaedic Trauma is the most commonly practiced. Recently there has been a significant demand for an evidence base with more t...
Purpose
The aim of this study was to examine the patient-reported outcomes of patients presenting with post-traumatic osteomyelitis (PTOM) of the lower limb over the past 15 years. This period was chosen to reflect modern treatment principles and increased centralisation of care.
Methods
An electronic literature search of the relevant databases (P...
PurposeThe primary aim was to analyse the lateral malleolus morphology with a focus on the shape of the distal fibula for IM fixation of the fibula in infra- and transsyndesmotic fracture patterns. The secondary aim was to propose a treatment algorithm according to the lateral malleolar anatomy.Methods77 healthy, skeletally mature volunteers underw...
Introduction
Trauma is widespread in Central and South America and is a significant cause of morbidity and mortality. Providing high quality emergency trauma care is of great importance. Understanding the barriers to care is challenging; this systematic review aims to establish current the current challenges and barriers in providing high-quality t...
Purpose
To investigate the incidence and the outcome of post-traumatic and iatrogenic sciatic nerve palsy (SNP) associated with fractures of the acetabulum. The results of sciatic nerve grafting for treatment were also investigated.
Methods
PUBMED, SCOPUS and COCHRANE databases were searched for longitudinal observational studies reporting sciatic...
Fracture non-union, prosthetic joint infection and fracture-related infections are complications frequently encountered by the trauma and orthopaedic surgeon. Moreover, they pose a significant socioeconomic and healthcare burden to the society. A clear understanding of the molecular biology surrounding fracture healing, as well as the pathophysiolo...
Background:
The incidence of hip fractures and subtrochanteric fractures in particular is increasing, along with the globally expanding aging population. Intramedullary nailing remains the 'gold standard' of their treatment. Blood loss can be a result of the original trauma, but also secondary to the subsequent surgical insult, especially during t...
Background:
Long bone fractures display significant non-union rates, but the exact biological mechanisms implicated in this devastating complication remain unclear. The combination of osteogenetic and angiogenetic factors at the fracture site is an essential prerequisite for successful bone regeneration. The aim of this study is to investigate the...
Purpose
High clinical success rates have been reported with the Masquelet technique in the treatment of traumatic bone loss. An increasing number of studies suggest that various factors can influence the properties of induced membranes. Goal of this systematic review is to answer the following questions: (1) which are the ideal spacer properties (m...
PurposeThere is relatively limited large scale, long-term unified evidence to describe how quality of life (QoL) and functional outcomes are affected after polytrauma. The aim of this study is to review validated measures available to assess QoL and functional outcomes and make recommendations on how best to assess patents after major trauma.Method...
Purpose
To compare the CFR-PEEK plates with conventional plates in fracture fixation with regards to clinical and radiological outcomes and complications.
Methods
A systematic literature search was conducted in four online databases independently by two reviewers using the Cochrane methodology for systematic reviews. The identified relevant studie...
Purpose
The aim of this study was to identify factors associated with the need for open reduction in subtrochanteric femoral fractures and investigate the effect of cerclage wiring compared to open reduction alone, on the development of complications, especially infection and non-union.
Methods
All consecutive patients with a fracture involving th...
Traumatic bone defects represent a complex clinical scenario and a major cause of patient disability. Advances in fixation methods, bone reconstruction, soft tissue management, and antibiotics have led to an increase in limb salvage rates. Autogenous bone grafting remains the gold standard for small defects, while distraction osteogenesis, vascular...
Meta-analyses constitute fundamental tools of the Evidence-Based Medicine (EBM) aiming at synthesizing outcome data from individual trials in order to produce pooled effect estimates for various outcomes of interest. Combining summary data from several studies increases the sample size, improves the statistical power of the findings as well as the...
Background:
Hemophilic knee arthritis is one of the most common presenting symptoms of hemophilia, and its management continues to be challenging to practitioners. Preliminary research has suggested that platelet-rich plasma (PRP) may have short-term efficacy in the treatment of hemophilic knee arthritis, but evidence for this treatment is limited...
With an ever-ageing population, the incidence of hip fractures is increasing worldwide. Increasing age is not just associated with increasing fractures but also increasing comorbidities and polypharmacy.
Consequently, a large proportion of patients requiring hip fracture surgery (HFS) are also prescribed antiplatelet and anti-coagulant medication....
Introduction
The recently developed femoral neck system (FNS) for treatment of femoral neck fractures (FNF), comprises theoretical biomechanical advantages compared to other implants. The aim of this study was to validate the safety and to report outcomes of patients treated with the FNS.
Method
A retrospective multicentric analysis of patients tr...
Purpose
To identify if older adults are more susceptible to acute muscle atrophy compared to younger adults.
Methods
All studies whose design involved a period of enforced immobilisation and a comparison between an older (> 40) and a younger cohort (< 40) were included. Outcome of interest was change in muscle mass, measured by radiological techni...
Objectives:. To report our experience and clinical results of using the Masquelet technique for the treatment of tibial nonunions and acute traumatic tibial bone defects.
Design:. Retrospective study of prospectively collected data (Level IV).
Setting:. Level I trauma center in the UK.
Patients/Participants:. Consecutive patients with tibial nonuni...
The Evidence-based medicine (EBM) movement, undoubtably one of the most successful movements in medicine, questions dogma and “clinical authority” and combines the “best available evidence” with clinical expertise and patient values in order to provide the best care for the individual patient. Although since its inception in the 1990s its strong th...
Articular fractures of the distal humerus in adults are challenging fractures requiring adequate surgical exposure for optimum reconstruction. Most commonly, an articular osteotomy of the olecranon is performed, but complications have been reported related to both creating and repairing the articular osteotomy. We describe the use of an extra-artic...
Posterior-wall acetabular fractures have been reported to be associated with marginal impaction characteristics in approximately 16% to 38% of cases1-3. Early recognition of this special entity of joint impaction is essential for effective preoperative planning, intraoperative execution, and favorable outcomes. The 2-level reconstruction technique...
Chronic musculoskeletal anterior pelvic pain may originate from a variety of different sources making the diagnosis difficult. Ectopic bone formation on the pubic symphysis is extremely rare and may cause significant disability. Reported herein is the case of a very active patient with symphysis pubis ectopic bone formation causing disability for m...
Objectives:
To determine whether open reduction and internal fixation (ORIF) of periprosthetic Vancouver B2 fractures can lead to successful fracture healing in selected patients, when attention is given to the surgical exposure and the creation of a balanced extramedullary construct.
Design:
Retrospective.
Setting:
2 level one trauma centers...
We have developed two-layered osteoconductive and antibacterial scaffolds, which mimic the natural structure of bone. The synthetic cortical (Type-1) biomaterialsBiomaterials were fabricated from porous titaniumTitanium embedded with 10% iron-doped brushite minerals. The trabecular (Type-2) biomaterials were fabricated from freeze-dried porous chit...
We have developed two-layered osteoconductive and antibacterial scaffolds, which mimic the natural structure of bone. The synthetic cortical (Type-1) biomaterials were fabricated from porous titanium embedded with 10% iron-doped brushite minerals. The trabecular (Type-2) biomaterials were fabricated from freeze-dried porous chitosan embedded with 1...
We present a case of spontaneous osteomyelitis of the left ulna in a 25-year-old man. There was no history of trauma or haematogenous source identified. Bone biopsy found staphylococcus aureus on culture, sensitive to flucloxacillin, but antibiotic treatment was unsuccessful. He underwent excision of the osteomyelitic ulna and a vascularised free f...
Objective
To determine if there was a difference in the risk of post-operative complications associated with the use of different intramedullary (IM) devices in the treatment of unstable AO OTA 31-A trochanteric fractures.
Design
Systematic literature review and meta-analysis.
Methods
A systematic literature review was carried out in January 2022...
Critical-size long bone defects represent one of the major causes of fracture non-union and remain a significant challenge in orthopaedic surgery. Two-stage procedures such as a Masquelet technique demonstrate high level of success however their main disadvantage is the need for a second surgery, which is required to remove the non-resorbable cemen...
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The Reamer-Irrigator-Aspirator (RIA-2) system has been established as a safe and reliable device to harvest large amounts of autograft. Nevertheless, hardware complications may occur. Breakage of the reamer head from the drive shaft with intramedullary retention of small metal debris has never been dealt with. The authors provide a technical trick...
Even though fifth metatarsal fractures represent one of the most common injuries of the lower limb, there is no consensus regarding their classification and treatment, while the term ‘Jones’ fracture has been used inconsistently in the literature.
In the vast majority of patients, Zone 1 fractures are treated non-operatively with good outcomes.
Tre...
Background
Bilateral acetabular fractures constitute a rare entity, and their optimal management is unknown.
Materials and Methods
A systematic literature search was conducted in PubMed, Embase and Cochrane Library between 1995 and 2020. Inclusion criteria were studies presenting cases of bilateral acetabular fractures and reporting outcomes. Extr...
Fracture non-union represents a common complication, seen in 5%–10% of all acute fractures. Despite the enhancement in scientific understanding and treatment methods, rates of fracture non-union remain largely unchanged over the years. This systematic review investigates the biological, molecular and genetic profiles of both (i) non-union tissue an...